Loan Application Type And Amount of Credit You're Requesting Loan Type Amount Requested Length of Loan (months) Loan Purpose $ Applicant General Information Please indicate your marital status. Member Account Number Birthdate (mm/dd/yyyy) MarriedSeparatedUnmarried Last Name First Name M.I. SSN/TIN Address City State ZIP Code Years There Own or Rent? Phone OwnRent Email Address Income Employer Position Years with Employer Hours per week Gross Income Other Income $ $ Income Time Unit Other Income Time Unit AnnualMonthlyBi-weeklyWeekly AnnualMonthlyBi-weeklyWeekly Spousal support, child support, or separate maintenance income need not be revealed if you do not choose to have it considered for repayment of this loan. Co-Applicant General Information Please indicate your marital status. Member Account Number Birthdate (mm/dd/yyyy) MarriedSeparatedUnmarried Last Name First Name M.I. SSN/TIN Address City State ZIP Code Years There Own or Rent? Phone OwnRent Email Address Income Employer Position Years with Employer Hours per week Gross Income Other Income $ $ Income Time Unit Other Income Time Unit AnnualMonthlyBi-weeklyWeekly AnnualMonthlyBi-weeklyWeekly Spousal support, child support, or separate maintenance income need not be revealed if you do not choose to have it considered for repayment of this loan. Both Applicants Debts Mortgage/Rent/Credit Cards Balance Payment Assets Autos Owned Year Make/Model Balance Payment Car - 1 Car - 2 Car - 3/RV/Boat Questions Have you ever had a repossession? YesNo Have you ever filed Bankruptcy? YesNo Are there any judgments or liens against you? YesNo Are you a co-signer on any other loan? YesNo Are you a US citizen? YesNo Comments on Questions? Applicant References Full Name Address (Street Address, City, State, ZIP) Phone Relationship Full Name Address (Street Address, City, State, ZIP) Phone Relationship Application Submission I understand I must be a member in good standing to obtain a loan from my credit union. I certify that statements on this application are true and complete. I authorize any person, association, firm, or corporation to furnish, on request of this credit union, information concerning me or my financial affiars. Best number to contact me Best time to contact me If you have any questions regarding your application, please contact us at (913) 647-9490. Please enter the security code below